Is annual better than biennial mammography for high-risk women aged 50-74 years?

  • Chiarelli AM & al.
  • J Natl Cancer Inst
  • 24 Jun 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A large Canadian cohort study finds higher sensitivity but lower specificity for many high-risk women aged 50-74 years.

Why this matters

  • Findings suggest no change to the current Ontario Breast Screening Program (OBSP) recommendation that high-risk women aged 50-74 years receive annual mammography.

Study design

  • Retrospective cohort from Ontario, Canada, compares sensitivity and specificity of annual vs biennial mammography across 3 high-risk groups: family history of breast or ovarian cancer or personal history of ovarian cancer (n=67,795), mammographic density ≥75% (n=51,956), or both (n=3758).
  • Annual or biennial screening mammograms were performed with digital mammography between 2011 and 2014 and followed until 2016 or breast cancer diagnosis.
  • Funding: Canadian Cancer Society.

Key results

  • Familial or personal history group (annual vs biennial mammography):
    • Higher sensitivity: 81.7% vs 70.6% (aOR, 1.86; 95% CI, 1.48-2.34); especially for invasive breast cancer (aOR, 1.87; 95% CI, 1.46-2.39) and postmenopausal women (aOR, 1.89; 95% CI, 1.49-2.39).
    • No difference in specificity.
  • Mammographic density ≥75% (annual vs biennial mammography):
    • No difference in sensitivity.
    • Lower specificity: 91.3% vs 92.3% (aOR, 0.87; 95% CI, 0.80-0.96).
  • Both family or personal history+mammographic density ≥75% (annual vs biennial mammography):
    • No difference in sensitivity.
    • No difference in specificity.

Limitations

  • Observational, retrospective design.
  • Follow-up periods not comparable between cohorts.
  • No use of 3D mammography.